User:Alexander Lee Schmidt/Sandbox 1

Structure

The main ingredient of NitroDura is 1,2,3-propanetriol trinitrate a/k/a . Nitroglycerin is molecule that when broken down to nitric oxide binds to protein domains found in smooth muscle. These binding domains are often found in the form of dimers that require multiple NO molecules to bind as seen in . The Nitric Oxide is often buried deep within the protein, that in conjunction with other molecular interactions triggers structural changes that activate proteins to serve their specific functions (). In humans, NO binds to protein domains in this same fashion as seen in .

Medication Details

The medical delivery method for Nitroglycerin can come in the form of tablets (that dissolved under the tongue, or in the cheek), topical ointments, or patches ^[1]. Nitro-Dur delivers nitroglycerin to the body in the form of an acrylic patch ^[2]. The NitroDur patch itself is composed of four layers that each serve a specific function in delivering an adequate dosage of nitroglycerin to the body. The exposed outermost layer of the patch is made up of aluminized plastic that is impermeable to nitroglycerin. This material prevents nitroglycerin from escaping through the back of the patch and directs the molecule to diffuse in the desired direction of toward the skin. The next layer consists of the actual nitroglycerin adsorbed in a mixture of lactose, colloidal silicon dioxide, and silicone medical fluid. The third layer is an ethylene-vinyl acetate copolymer layer that is selectively permeable to the desired nitroglycerin molecule. The final layer that functions to adhere the patch to the skin is composed of hypoallergenic silicone ^[3].

Function

Nitroglycerin is commonly used to treat various conditions involving the heart. It used to increase the chances of detecting coronary artery disease when using MR coronary artery imaging (MRCA). Nitroglycerin increases the vessel length allowing coronary artery disease to be more visible under MRCA ^[4]. Nitroglycerin is also used to treat heart disease and angina which is classified as heart pain. Angina is caused by inadequate flow of oxygen and blood to the heart. To prevent this problem, nitroglycerin is used and will open up the blood vessels. This widening of the blood vessels allows the heart to do less work requiring less oxygen and blood ^[1].

Disease

Heart Disease

Nitroglycerin can be found in the form of a topical ointment, acrylic patch, or in the form of tablets to be dissolved under the tongue or cheek ^[1]. The acrylic patch is in the form of Nitro-Dur and delivers nitroglycerin to the body ^[2]. Nitroglycerin is commonly used to treat various conditions involving the heart. It’s used to increase the chances of detecting coronary artery disease when using MR coronary artery imaging (MRCA). This is done by increasing the vessel length allowing coronary artery disease to be more visible under MRCA ^[4]. Nitroglycerin is also used to treat heart disease and angina which is classified as heart pain. Angina is caused by inadequate flow of oxygen and blood to the heart. To prevent this problem, nitroglycerin is used and will open up the blood vessels. This widening of the blood vessels allows the heart to do less work requiring less oxygen and blood ^[1].

Chronic Achilles Tendinopathy

Chronic Achilles Tendinopathy is a pain in the achilles tendon that is caused by tendon degradation ^[5]. A study conducted at an Australian University Hospital looked at the effect of topical glyceryl trinitrate on pain and symptoms in chronic noninsertional Achilles tendinopathy. Participants were assigned an active transdermal patch (1/4 of a Nitro-Dur 5 [Schering-Plough] glyceryl trinitrate patch), which delivered 1.25 mg of glyceryl trinitrate over 24 hours, or a placebo patch. Patients were required to cut the patches into quarters and apply 1/d to the site of maximal tenderness for the 24-week duration of the study. The main result of this study showed that the use of a nitro-dur patch was more effective than placebo for reducing pain from chronic noninsertional Achilles tendonitis in the first 12 and 24 weeks ^[6].

Raynaud’s Phenomenon

The Raynaud's pehnomenon occurs due to vasoconstriction of the capillaries, veins, and arteries in external digits ^[1]. Symptoms of raynaud’s involves the fingers or toes turning pale, becoming numb, and then becoming purple or blue. These symptoms result from attacks that can are characterized by spasms in the small blood vessels of the fingers and toes ^[7]. Patients who have been diagnosed with Raynaud’s phenomenon will occasionally need pharmacologic therapy. While the nitro-dur patch is not specifically used, topical nitroglycerin can be prescribed to these patients and decreases the occurrence and severity of vasospastic episodes ^[1]. Nitroglycerin does this by expanding the blood vessels allowing blood to better circulate ^[4].